Provider Demographics
NPI:1134394737
Name:WELLER, BARBARA JANE
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANE
Last Name:WELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 MCQUADE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2943
Mailing Address - Country:US
Mailing Address - Phone:218-525-2059
Mailing Address - Fax:218-525-1864
Practice Address - Street 1:5170 MCQUADE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2943
Practice Address - Country:US
Practice Address - Phone:218-525-2059
Practice Address - Fax:218-525-1864
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN270757800OtherMEDICAL ASSISTANCE